Provider Demographics
NPI:1548665540
Name:VANNATTA, RACHEL LEE (LGPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LEE
Last Name:VANNATTA
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 KENILWORTH DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2139
Mailing Address - Country:US
Mailing Address - Phone:443-841-7785
Mailing Address - Fax:
Practice Address - Street 1:1122 KENILWORTH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2139
Practice Address - Country:US
Practice Address - Phone:443-841-7785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP3745101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health